儿童青少年2型糖尿病

2型糖尿病是一类异质性疾病 ,是以胰岛素抵抗为主的胰岛素相对性缺乏 ,或胰岛素分泌受损为主的伴有或不伴有胰岛素抵抗所致的糖尿病 ,多发生在成人 ,但近年来因生活方式的变化 ,肥胖儿童的发病率明显增高 ,使儿童及青少年2型糖尿病发病率有逐年增高的趋势。遗传因素在发病中起着重要作用 ,肥胖、高血压及运动不足是 2型糖尿病的主要危险因素。流行病学2型糖尿病是一种全球性流行性疾病 ,最近世界卫生组织 (WHO)发布的资料表明 ,当前全球大约有 1 5亿的糖尿病患者 ,到 2 0 2 5年将达到 3亿人 ,增加的发病人数将主要分布在发展中国家。特别…     

儿童2型糖尿病及糖尿病前期患病率研究

目的：了解近10年2型糖尿病（T2DM）和肥胖儿童中糖尿病（DM）前期的患病情况及T2DM的发病趋势。方法：对2000年10月至2010年9月住院且新诊断的DM以及肥胖患儿的临床资料进行回顾性分析。结果：（1）共诊断DM患儿503例,其中T2DM 31例。前后5年比较,T2DM构成比则从0.05‰上升到0.18‰（P<0.01）。与前5年相比,近5年T1DM病例数增加了1.35倍,T2DM增加了4.20倍,T2DM构成比的增长幅度大于1型糖尿病（T1DM）（P<0.05）。（2）1301例肥胖儿童接受口服葡萄糖耐量试验,其中29例确诊为T2DM,255例为DM前期。DM前期255例中,合并脂代谢紊乱133例,非酒精性脂肪肝病138例,高血压53例。结论：近5年T1DM和T2DM患病率均有明显增加,T2DM的增长快于T1DM。肥胖儿童DM前期的发生率较高,潜在发生T2DM以及心血管病变风险大。     

儿童青少年2型糖尿病的流行现状、危险因素及病理生理学机制的研究进展

儿童青少年2型糖尿病发病率日益增高,了解该病的流行现状、危险因素及病理生理学机制十分重要.该病的流行存在明显种族差异性,其危险因素包括肥胖、2型糖尿病家族史、母亲妊娠期高血糖、胎儿宫内发育迟缓及出生体质量异常等,主要通过胰岛素抵抗和胰岛素分泌缺陷这两大病理生理学机制影响血糖.     

上海市闵行区儿童青少年非酒精性脂肪肝病7年患病率横断面调查

背景：儿童非酒精性脂肪肝病（NAFLD）导致成年后心血管病发病风险明显增加,而目前我国儿童青少年一般人群NAFLD患病率研究十分有限,长期变化趋势亦不明确。目的：描述儿童青少年NAFLD患病流行趋势。设计：横断面调查。方法：以上海市闵行区2014至2020年参加健康体检的住校学生为调查对象。将ALT水平高于一般人群性别和年龄别P97.5水平定义为疑似NAFLD,依此估计疑似NAFLD患病率（简称患病率）。根据全国标准分别以BMI和腰围定义一般性肥胖和腹型肥胖。通过计算平均年度变化百分比（AAPC）及其95%CI行描述NAFLD患病率逐年变化幅度,趋势性检验Logistic回归分析,并校正BMI和腰围。主要结局指标：NAFLD患病率。结果：NAFLD总体患病率为5.1%,从2014年至2020年上升了2.5倍（2.1%到7.4%）,NAFLD患病率逐年上升（Ptrend<0.001）,AAPC为0.9%（95%CI：0.1%~1.7%）,且男孩高于女孩（6.3% vs 3.7%）。在体重正常人群中NAFLD患病率为1.9%,7年中呈逐年上升趋势（Ptrend<0.001）。调整BMI和腰围后,NAFLD患病率逐年上升的趋势仍显著（Ptrend<0.001）。结论：上海儿童青少年人群NAFLD患病率呈现每年上升近1.0%的趋势,调整BMI和腰围因素后,NAFLD患病率逐年上升的趋势仍然存在。提示除肥胖外,儿童人群防控NAFLD需进一步关注其他可干预危险因素的作用。     

儿童青少年2型糖尿病的诊断及治疗

随着世界范围肥胖者的增加,2型糖尿病(T2DM)在儿童及青少年中的发病率也明显上升.儿童青少年T2DM的病因也是由遗传、环境等多因素相互作用的结果.重要的危险因素包括肥胖、T2DM家族史、高危种族及胰岛素抵抗表型.为及早诊断及治疗,对具有危险性的儿童应进行T2DM筛查.筛查的指征包括肥胖和其他2个危险因素.儿童青少年T2DM的诊断标准同成人,基于空腹、随机血糖及口服糖耐量试验的标准值.防治T2DM的重要措施是改善生活方式、减低或控制体质量.此外,还可应用二甲双胍和(或)胰岛素.控制高血压及血脂紊乱及监测微血管并发症也很必要.实用儿科临床杂志, 2009, 24(8 ): 638-640     

儿童和青少年2型糖尿病诊治进展北大核心CSCD

随着肥胖的流行,儿童和青少年2型糖尿病（T2DM）在世界范围内明显增加,对高危人群的筛选和诊断 T2DM 非常重要。儿童和青少年 T2DM 除了生活方式的改变外,推荐的最佳药物治疗为二甲双胍和胰岛素。为减少心血管疾病的风险,应充分认识儿童和青少年 T2DM 和并发症,并更好地评价和管理。     

1型糖尿病青少年患者血糖控制和糖尿病微血管并发症

为了解1型糖尿病青少年患者的血糖控制情况、糖尿病微血管并发症的发生率及其危险因素 ,调查病程5年以上的1型糖尿病患者76例 ,平均年龄17.2±3.9岁 ,平均病程9.0±3.4年 ,检测餐后2小时血糖、糖化血红蛋白 (HbA1C)、尿微量白蛋白 ,眼底荧光造影等。结果显示 ,HbA1C 平均水平为 (9.7±1.7) % ;糖尿病肾病发生率为9.2% ,微量白蛋白尿 (UAER :20～200μg/min)和大量蛋白尿 (UAER>200μg/min)分别占7.9 %和1.3 %;糖尿病视网膜病变发生率为23.7% ,非增殖型16例占21.1% ,增殖型2例占2.6 % ,其中3例合并白内障。提示目前1型糖尿病青少年患者的血糖控制不理想 ,仅有18.4 %的患者HbA1C <8 % ;长病程、女性、血糖控制差是1型糖尿病青少年发生糖尿病视网膜病变、糖尿病肾病的危险因素     

新疆和田地区维吾尔族儿童糖尿病患病率调查

目的 调查新疆和田地区维吾尔族儿童糖尿病（diabetes mellitus,DM）患病率,以及DM患病的影响因素。 方法 采用整群随机抽样的方法抽取新疆和田地区5 308名在校中小学、幼儿园4~18岁儿童作为研究对象。调查方式包括问卷调查及身高、体重测量。对所有研究对象进行空腹指尖微量血糖检测,以调查DM和空腹血糖受损（impaired fasting glucose,IFG）的患病率。 结果 回收有效问卷5 184份,检出DM 14例（0.27%）,包括8例1型DM,2例2型DM,4例未分型DM;检出IFG 29例（0.56%）。男生和女生DM及IFG患病率的比较差异无统计学意义（P>0.05）。4~<10岁、10~<15岁和15~18岁组DM的患病率分别为0.18%、0.47%、0.07%,各年龄组比较差异无统计学意义（P=0.072）;以上3个年龄组IFG的患病率分别为0.18%、0.94%、0.42%,各年龄组间比较差异有统计学意义（P=0.007）。DM儿童DM家族史比例和超重/肥胖比例显著高于非DM儿童（P<0.05）,而DM儿童喜食粗粮比例显著低于非DM儿童（P<0.05）。 结论 新疆和田地区维吾尔族儿童DM和IFG的患病率较低;不同性别和年龄段儿童DM患病率无明显不同,但不同年龄段儿童IFG患病率不同。DM家族史、超重/肥胖、粗粮摄取不足可能与DM的发生有关。     

上海市儿童及青少年慢性头痛的流行病学调查

目的研究上海市儿童及青少年慢性头痛的流行情况及特点,调查慢性头痛的影响状况及就诊情况。方法将上海市中小学生（6～15岁）进行分层整群随机抽样,采用问卷调查及专科随访的方式,调查慢性头痛的患病情况、头痛特点、影响因素及就诊情况。结果（1）患病情况：共调查9857名学生,回收问卷8701份,回收率为88．6％,1481／8701（17％）有过头痛的经历,86．4％头痛原因不明;慢性头痛的患病率为7．8％,性别差异无统计学意义（x^2=0．010,P〉0．05）。（2）慢性头痛的患病率随年龄的增加而增高,12岁前男性高于女性,12岁后女性超过男性。（3）儿童慢性头痛特点：头痛部位单侧、双侧或不详比例相似,颞部居多（35．2％）,额部次之（25．6％）;头痛持续时间短,消化道伴随症状突出;头痛程度,48．5％的患儿认为头痛影响学习、生活;头痛伴随症状以消化道症状最常见。（4）就医情况：24．0％的患儿就诊,其中30．9％的患儿头痛后寻求药物治疗。（5）相关影响因素：慢性头痛的常见诱因为过度疲劳（51．4％）,睡眠不足（40．4％）,情绪改变（38．5％）,学习压力（2,4．1％）;慢性头痛与阳性家族史、学习压力过大有关。结论慢性头痛是儿童常见的临床问题,近半数慢性头痛儿童的学习与日常生活受到影响,但多数患儿未得到医疗指导,此调查结果应引起医学、教育及社会的共同关注。     

儿童青少年1型糖尿病合并乳糜泻研究现状

1型糖尿病(type 1 diabetes mellitus,T1DM)和乳糜泻(celiac disease,CD)都是在环境因素参与下、遗传易感个体发生的自身免疫性疾病,与一般人群相比,T1DM儿童青少年CD的患病率明显升高。T1DM合并CD的儿童青少年大多缺乏典型CD症状,容易漏诊或误诊,延误治疗;更易出现低血糖...     

Type 2 diabetes mellitus in European children and adolescents

Aim: The aim of the study was to review the published and unpublished data on type 2 diabetes in European children in order to determine how common this problem is in the dominantly Caucasian population. Methods: The MEDLINE database was searched and a questionnaire was distributed among European Childhood Obesity Group (ECOG) representatives from 16 countries. Results: One hundred and eighty-four children with type 2 diabetes were diagnosed in Europe, 144 of them of Caucasian origin. The majority of them were overweight females and, had positive family history for type 2 diabetes mellitus.

Conclusion: Because of the significant rates of type 2 diabetes in Europe, screening for it in obese children and adolescents is highly recommended.     

儿童和青少年1型糖尿病流行病学及治疗研究进展

1型糖尿病作为儿童和青少年糖尿病的主要类型,近20年来发病率有明显的增加趋势,引起全世界越来越多的关注.该文综述了近年来国内外儿童和青少年1型糖尿病流行病学、治疗和管理方面的研究进展,通过对比国内外儿童和青少年糖尿病学研究进展,可以更好地了解我国儿童糖尿病研究方面与世界研究方面的差距,从而为我国以后的研究指明方向.     

Latex allergy risk assessment in children and adolescents with type I diabetes mellitus

An increased frequency of allergic reactions to latex has been reported in specific populations with chronic latex exposure. However, relevance of latex allergy to children and adolescents with type I diabetes mellitus (DM1) has not been studied yet. The aim of the studty is to assess latex allergy risk in children and adolescents with DM1. Thirty-nine children with DM1 and 35 controls were enrolled. In a case-control study, we applied to all subjects a standard questionnaire, and specific Immunoglobulin E (IgE) concentrations for latex, common aeroallergens, and food-allergens were measured in serum samples. Latex exposure rates by means of medical procedures, operations, and latex glove usage were not different between DM1 and controls. Symptoms due to latex exposure were not determined in both groups. Three (7.7%) subjects in DM1 tested positive for latex-specific antibodies (LSIE), whereas no subject in controls. Diabetics that tested positive for latex-specific antibodies had the disease for three, 5 and 8 years. Nine (23.1%) of diabetics, and two (5.7%) of controls were atopic (p = 0.04). In our investigation, we found that children and adolescents with DM1 are not a risk group for latex allergy, and LSIE in children with DM1 was not accompanied by symptoms of latex allergy, or, presumably, increased risk of latex anaphylaxis.     

Type 2 diabetes mellitus is rare but not absent in children under 15 years of age in Austria

Until recently, most children with diabetes mellitus had type 1 diabetes (T1DM). The prevalence of type 2 diabetes (T2DM) is on the rise in North America, especially in risk populations such as the American Indians. Few epidemiological data on the incidence of the disease exist in Europe. In a prospective population-based epidemiological study, all newly diagnosed cases of diabetes mellitus in patients under 15 years of age were registered nation-wide in Austria between 1999 and 2001. Differential diagnosis (according to the American Diabetes Association diagnostic criteria) was based on clinical case definition. During the 3 years of the study period, 529 cases of DM <15 years were documented, of which 510 were clinically assigned to T1DM (271 boys, 239 girls) resulting in an incidence rate of 12.4/100,000. In the same network, eight cases were diagnosed as T2DM (one boy, seven girls) and two cases with an atypical form of T2DM (two girls). The age of onset of T2DM was 12–15 years and all patients were overweight (body mass index >90th percentile).The calculated incidence for T2DM <15 years in Austria was 0.25/100,000. Conclusion: at present, type 2 diabetes mellitus is rare but exists in children aged under 15 years in Austria. Follow-up of this registration will help to describe the secular trend.Abbreviations BMI body mass index - GAD glutamic acid decarboxylase - IAA insulin autoantibody - IA2 tyrosine like phosphatase - MODY maturity onset diabetes in the young - T1DM type 1 diabetes mellitus - T2DM type 2 diabetes mellitus Members of the Austrian Diabetes Incidence Study Group: Arocker W., Bauer M., Baumgartner F., Bali C., Borkenstein M., Bittmann B., Coradello H., Dorninger L., Fussenegger J., Jäger A., Gröblacher H., Guttenberger K. H., Häckel F., Heijbl L., Höller W., Holzer H, Holzleitner C., Jäger A., Jürgenssen O. A., Kovac U., Kitzler P., Köfler T. H., Kurnik P., Lindauer E., Meisel A., Moser G., Mühleder J., Müller G., Müllner M., Paier R., Popper-Preising C., Prchla C., Rausch-Schott G., Rauscher R., Reindl R., Resch R., Rezaka E., Rittinger O., Rubens K., Salzer H., Schally-Stebl A., Schermann A., Schlager J., Schmitt K., Schneider U., Sellner-Horstmann S., Sonnberger H, Stainer A., Steichen E., Stöllinger O., Sulzer M., Von den Thannen T., Walser I, Wakolbinger G., Weinhandl G., Wutte A., Zieglauer H., Zwiauer K.     

Microvascular complications in children and adolescents with type 1 diabetes mellitus in Assiut governorate,Egypt

Background

Type 1 diabetes mellitus (T1DM) carries a long-term burden of increased microvascular complications in the form of nephropathy, retinopathy, and neuropathy. As the incidence of T1DM continues to rise, the burden of microvascular complications will also increase and negatively influence the prognosis of young patients. Microalbuminuria (MA) represents the earliest clinical indication of diabetic nephropathy and is a predictor of increased cardiovascular morbidity and mortality. Our study’s aim was to determine the prevalence of microvascular complications among type 1 diabetic patients in Assiut University Children Hospital, Upper Egypt and to find out its correlation with various risk factors.

Initial insulin therapy in children and adolescents with type 1 diabetes mellitus

Weitzel D, Pfeffer U, Dost A, Herbst A, Knerr I, Holl R. Initial insulin therapy in children and adolescents with type 1 diabetes mellitus. Objective: The aim of the study was to define parameters that influence the initial insulin dosage in young subjects with type 1 diabetes regarding the amount of daily insulin, the ratios of basal and prandial insulin, and the insulin/carbohydrate ratios. Study design: We used a computer‐based registry (with prospectively collected data) in Germany and Austria, a software for the management and data documentation of diabetic patients (DPV), to analyze the initial insulin therapy in 2247 children with newly diagnosed type 1 diabetes to identify factors that influence diabetes therapy within the first 10 d. Results: For both genders, glucosylated hemoglobin A1c (HbA1c), blood pH at diabetes onset, and pubertal status are the major factors determining the initial insulin dosage calculated as the amount of daily insulin per kilogram body weight (kg), the basal and prandial insulin dose per kilogram, and day and the insulin/carbohydrate ratios for meals. The frequency of hypoglycemia correlated with increasing quotient of applied to calculated insulin dosage. Conclusion: The predictive factors of insulin requirement may exert beneficial effects on the assessment and adjustment of insulin therapy in young diabetic subjects at disease onset. On the basis of a multiple, linear regression, we suggest a formula to calculate the initial insulin therapy.     

骨保护素与2型糖尿病的关系

2型糖尿病是一种严重威胁人类健康的内分泌疾病.近年来的研究发现,骨保护素与2型糖尿病关系密切.2型糖尿病患者循环系统、胰腺、肝脏及脂肪中的骨保护素水平均有改变.骨保护素还与糖尿病血管并发症的发生相关,已有很多学者对此进行了探讨.该文综述骨保护素与2型糖尿病发生、发展的关系,旨在为糖尿病的治疗提供新的思路.     

Psychological issues in the care of children and adolescents with type 1 diabetes

The present article highlights some of the psychological issues in children and adolescents with type 1 diabetes and provides health professionals with some strategies for addressing them.